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Blood test results are NOT acceptable evidence of immunity against diphtheria tetanus or pertussis DTP/DTaP/Tdap/DT/Td. CITY ZIP RECORD OF IMMUNIZATIONS See Notes On Other Side Vaccines Type Dose DTP-DTaP-DT Mo/Day/Yr Polio Hib Hep B PCV Rotavirus MCV HPV Hep A MMR Tdap MenB Other To the best of my knowledge the vaccines listed above were administered as indicated. History of Varicella Disease Mo/Yr Td Clinic / Office Name Office Address/ Phone Number 1. The minimum vaccine requirements and...
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Maryland Department of Health (MDH) is the state agency responsible for protecting public health and providing healthcare services in the state of Maryland.
Healthcare facilities, healthcare providers, and other entities involved in healthcare delivery are required to file the Maryland Department of Health.
Maryland Department of Health forms can be filled out online on the MDH website or submitted by mail.
The purpose of the Maryland Department of Health is to monitor and improve public health, regulate healthcare providers, and ensure the delivery of quality healthcare services.
Information such as patient demographics, healthcare services provided, and any healthcare-related incidents or outbreaks must be reported on the Maryland Department of Health.
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